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Mediation analysis of leisure activities on the association between cognitive function and mortality: a longitudinal study of 42,942 Chinese adults 65 years and older
Xingxing Chen, Wenfan Wu, Xian Zhang, Tingxi Long, Wenyu Zhu, Rundong Hu, Xurui Jin, Lijing L. Yan, Yao Yao
Epidemiol Health. 2022;44:e2022112.   Published online November 27, 2022
DOI: https://doi.org/10.4178/epih.e2022112
  • 5,156 View
  • 249 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Previous studies have established associations of cognitive function and leisure activities with mortality. This study aimed to evaluate whether leisure activities causally mediate these associations.
METHODS
This longitudinal study included 42,246 participants aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey. The Mini-Mental State Examination and a self-reported scale were used to measure cognitive status and leisure activities, respectively. We examined the associations of cognitive function and leisure activities with mortality using Cox proportional hazards models. Causal mediation analysis was used to assess whether leisure activities mediated the association between cognitive function and mortality.
RESULTS
Cognitive function and leisure activities were inversely associated with mortality. Leisure activities accounted for 28.3% (95% confidence interval [CI], 25.6 to 31.1) of the total effect of cognitive function and mortality. A higher mediated proportion (PM) was observed for physical leisure activities (PM, 20.1%; 95% CI, 18.0 to 22.3) than for social leisure activities (PM, 17.7%; 95% CI, 15.7 to 19.7). The mediating effect was higher among participants at younger ages (PM, 41.5%; 95% CI, 21.3 to 65.4), those with higher education levels (PM, 30.5%; 95% CI, 25.3 to 36.2), and residents of rural China (PM, 42.5%; 95% CI, 25.4 to 62.5).
CONCLUSIONS
Cognitive function was associated with inverse mortality. Leisure activities significantly mediated this association. Participation in leisure activities at the early stages of mild cognitive impairment could reduce the risk of mortality, which has a major impact on interventional strategies for healthy aging.
Summary
Key Message
Both cognitive function and leisure activities were associated with inverse mortality. Leisure activities were an important mediator of the association between cognitive function and mortality. A planned intervention for leisure activities, at an early stage of mild cognitive impairment, could promote health outcomes and optimally reduce the risk of mortality.

Citations

Citations to this article as recorded by  
  • Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study
    Oscar H. Del Brutto, Denisse A. Rumbea, Aldo F. Costa, Maitri Patel, Mark J. Sedler, Robertino M. Mera
    Clinical Neurology and Neurosurgery.2024; 236: 108053.     CrossRef
  • Healthy lifestyle in late-life, longevity genes, and life expectancy among older adults: a 20-year, population-based, prospective cohort study
    Jun Wang, Chen Chen, Jinhui Zhou, Lihong Ye, Yang Li, Lanjing Xu, Zinan Xu, Xinwei Li, Yuan Wei, Junxin Liu, Yuebin Lv, Xiaoming Shi
    The Lancet Healthy Longevity.2023; 4(10): e535.     CrossRef
  • Associations of Unhealthy Lifestyle and Nonalcoholic Fatty Liver Disease With Cardiovascular Healthy Outcomes
    Wentao Wu, Wen Ma, Shiqi Yuan, Aozi Feng, Li Li, Haoxiao Zheng, Shuna Li, Ningxia He, Yuli Huang, Jun Lyu
    Journal of the American Heart Association.2023;[Epub]     CrossRef
Blood lipid levels and all-cause mortality in older adults: the Chinese Longitudinal Healthy Longevity Survey 2008-2018
Rongxi Wang, Xiaoyue Yu, Zhiqiang Wang, Yujie Liu, Hui Chen, Shangbin Liu, Chen Xu, Yingjie Chen, Xin Ge, Danni Xia, Ruijie Chang, Gang Xu, Mi Xiang, Ying Wang, Tian Shen, Fan Hu, Yong Cai
Epidemiol Health. 2022;44:e2022054.   Published online July 5, 2022
DOI: https://doi.org/10.4178/epih.e2022054
  • 7,341 View
  • 238 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Proper blood lipid levels are essential for survival in older adults, but inconsistent relationships have been reported between blood lipids and all-cause mortality in the elderly.
METHODS
This retrospective longitudinal study analyzed data from 1,067 Chinese older adults enrolled in the Chinese Longitudinal Healthy Longevity Survey collected in 2008 and followed up until death or December 31, 2018. The outcome was all-cause mortality. Multivariate Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with stratification by age (60-80, 80-100, or ≥100 years) for further analysis. The survival probability according to lipid profile quartiles was calculated using Kaplan-Meier curves and the log-rank test.
RESULTS
The participants’ mean age was 84.84 years, and 57.0% were female. In total, 578 individuals died, and 277 were lost to follow-up. The mean total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were higher among those who died than among those who survived. Participants in the second HDL-C quartile and the highest LDL-C and triglyceride (TG) quartiles had 28% higher, 23% lower, and 49% lower risks of all-cause mortality, respectively. After further adjustment, the associations remained except for HDL-C, and additional associations were observed between all-cause mortality and the third TC and LDL-C quartiles and the second TG quartile (HR, 1.44; 95% CI, 1.01 to 2.06; HR, 0.68; 95% CI, 0.49 to 0.94; HR, 0.79; 95% CI, 0.62 to 0.99, respectively).
CONCLUSIONS
Older adults should maintain an LDL-C level of 1.91-2.47 mmol/L and a TG level of no less than 1.66 mmol/L.
Summary
Key Message
The retrospective longitudinal study analyzed data from 1067 Chinese older adults enrolled in the Chinese Longitudinal Healthy Longevity Survey. 578 individuals died and 277 were lost to follow-up. Participants in the second HDL-C quartile and the highest LDL-C and TG quartiles had 28% higher, 23% lower, and 49% lower risks of all-cause mortality. After further adjustment, the associations remained except for HDL-C, and additional associations were observed between all-cause mortality and the third TC and LDL-C quartiles and the second TG quartile (HR, 1.44; 95% CI, 1.01 to 2.06; HR, 0.68; 95% CI, 0.49 to 0.94; HR, 0.79; 95% CI, 0.62 to 0.99).

Epidemiol Health : Epidemiology and Health